Beating AIDS in Brazil

RIO DE JANEIRO, Brazil (CNN) -- The zest for life in Brazil is legendary. Perhaps this is one of the reasons why the country actively confronted the mortal threat of AIDS early on.

For years, a HIV diagnosis seemed like a death sentence, but new complicated drug 'cocktails' have returned a measure of hope.

Brazil now distributes HIV drugs to every citizen who needs them. They are given away free to 90,000 people. This costs Brazil more than $330 million a year. Political will has sustained the programme, even through an economic crisis in the late 1990s.

The result is that the country's AIDS death rate has dropped 50 per cent. The infection rate is half what it was projected to be and there are far fewer hospitalisations.

The key ingredient of the programme is Brazil's generic drug strategy. State-owned laboratories such as Far-Manguinhos copy brand-name AIDS drugs, creating competition that has reduced the cost by 70 percent.

Brazil makes eight of the 12 drugs in the AIDS 'cocktail' for less than a third of the price in the U.S.

"There is fat in the price of this medicine. The companies say that what they spent in research and development to receive one new drug is around $500 million and our studies showed you can do the same thing with $50 million," Eloan Pinheiro, director-general of Far-Manguinhos, told CNN.

With that knowledge comes leverage. Pharmaceutical firm Merck recently slashed prices on one AIDS drug in Brazil by 65 percent after Pinheiro threatened to copy it.

"We've offered prices to the developing world that we think are the lowest possible prices," Raymond Gilmartin, President and CEO of Merck told CNN.

But Pinheiro spent 15 years working for international drug companies and she says their arguments sadden her.

"We are more concerned with human rights than patent rights or money rights or whatever rights."
Jaquelina Rocha, Brazilian campaigner for rights of HIV-infected

"I believe that they are losing the vision of the value of life. They are in a sense defining who may live and who shall die. They can't see that in the developing countries you have a smaller salary and a smaller income than in developing countries, and in less-developed countries you have more diseases and that these people, the people that live in these places must be saved too," she said.

Merck makes no apologies.

"We make a tremendous difference in the quality of life and we save lives with just about every one of the drugs that we introduce. I think it is well understood that in order to fund the research behind this, that pharmaceutical companies should be profitable," said Gilmartin.

Even at reduced prices, multinational drug companies are making a profit in Brazil. The country still buys more than half of its HIV drugs from major suppliers.

Community involvement

Valda Castiello dos Santos is a 55-year-old community AIDS educator who is HIV positive. She has been on medication for eight years.

"Without the government, I would now be dead, for sure. Sometimes I don't have the money to buy something to bring down a fever. When I catch a cold, I make the cough syrup myself because I can't afford to buy it," she told CNN.

"Only the drug cocktail, DDI, AZT and Crixivan, have allowed me to stay alive. Without them I surely would not be here," she said.

Unwilling to let the disease win, she does her bit by distributing free condoms and giving lessons in how to use them.

"I want to contribute with what I can to stop the advancement of this epidemic," she said.

Brazil estimates it has 5.4 million people living with HIV/AIDS

Community involvement like this is the key to Brazil's success.

A high profile advocate for the rights of the HIV infected, transsexual Jaquelina Rocha says Brazil's cultural openness has helped her and her cause.

"Instead of running away from the problem of the AIDS epidemic, Brazil came face to face with it, and to face an epidemic such as AIDS, you have to deal with all kinds of human beings," Rocha told CNN.

In the world's largest catholic country, even the church has been supportive.

There is universal access to prevention programmes, testing, counselling and treatment.

Brazil's approach to tackling AIDS has become an example to other developing nations.

The plan's early proponent was Brazil's first civilian president, now a senator, Jose Sarney.

"It was bigger than the politics; it was the attitude of an intellectual man, and of a statesman concerned with AIDS as a problem for human survival," said Sarney.

Trade dispute

But now Brazilians say their AIDS programme is threatened by a thorny trade dispute over Brazilian patent law.

Brazil spent $444 million on AIDS drugs in 2000 -- four per cent of its health budgetSource: New York Times 28 January 2001

The U.S. government filed a case a year and a half ago against Brazil at the
World Trade Organization (WTO) disputing a Brazilian law that says companies must manufacture their products in Brazil within three years or lose patent protection.

"By imposing this type of requirement, you would just block free trade of any merchandise or any product that is patented in Brazil," intellectual property adviser Otto Licks told CNN.

Brazil's health minister Jose Serra said: "We are not discussing free trade. We are discussing the interests of US pharmaceutical industry."

Tadeu Alves, Merck's managing director in Brazil said the law was not viable: "We cannot have plants in all countries where we operate."

Brazilian officials say losing the WTO case would limit their legal loopholes for copying patented drugs if drug-makers do not offer a fair price.

Perhaps not surprisingly, the other side disagrees.

There are also whispers that some of Brazil's flag-waving about AIDS serves the political ambitions of health minister Jose Serra, an assumed candidate for the presidency.

Brazil has been through other trade battles before -- over steel, shoes and even orange juice.

But having united all facets of its diverse society in the fight against AIDS, the country says it is not giving in on this one. Brazil sees it simply as a moral question, of nothing less than life or death.

There may yet be room for compromise. If both sides agree that the real end is neither politics nor profits, but people.